Fibroid Tumors

What are fibroids?

Fibroid tumors are usually benign (non-cancerous) tumors found, most often, in the uterus of women in their 30’s and 40’s, although they occasionally develop on other organs which contain smooth muscle cells.

Fibroid tumors are solid tumors which are made of fibrous tissue, hence the name ‘fibroid’ tumor. Most often fibroids occur as multiple tumor masses which are slow-growing and often cause no symptoms.

The size of fibroids varies widely among women and some are so small that a microscope is required to see them. However some women experience a single large fibroid tumor the size of a grapefruit or a fibroid which is so large it encompasses the entire abdominal area. Such large tumors can weigh as much as 50 pounds. The largest recorded fibroid weighed 140 pounds.

Fibroid tumors normally develop in the presence of too much estrogen, relative to too little progesterone. Additionally, they do not develop before the body begins producing estrogen during the onset of menstruation, and estrogen taken for menopausal symptoms, does cause fibroid tumors to grow. It is common for fibroid tumors to shrink during pregnancy when the body is producing increasing amounts of progesterone. After menopause, they almost always shrink and disappear due to the body’s reduced production of estrogen. A woman will almost never develop fibroid tumors after menopause.

The estrogen connection appears to be quite clear, although there are still some who doubt the role that estrogen plays in the development of fibroid tumors because women with fibroids often have blood levels which reveal normal amounts of estrogen. A more relevant measurement for assessing fibroid tumor development caused by too much estrogen is a saliva test.

Types of Fibroid Tumors

Submucous Fibroids: These fibroids occur just below the lining of the uterus and can cause menstrual problems, including pain as they grow and move around the pelvic area.

Intramural Fibroids: A round fibroid most often within the uterine wall which can cause enlargement of the uterus as they grow.

Subserous Fibroids: This fibroid grows on the outer wall of the uterus and usually causes no symptoms until it grows large enough to interfere with other organs.

Pedunculated Fibroids: These fibroids develop when a subserous fibroid grows a peduncle (stalk), as they grow larger they may become twisted and cause severe pain.

Interligamentous Fibroid: A fibroid which grows sideways between the ligaments which support the uterus in the abdominal region. This type of fibroid is especially difficult to remove without the possibility of interfering with the blood supply or other organs.

Parasitic Fibroid: The rarest form of fibroid tumor occurs when a fibroid attaches itself to another organ.

Diagnosis of Fibroid Tumors

Diagnosis of fibroids is generally made by your physician during your annual gynecological exam. They often are found when your physician is looking for something else or may never be discovered if you do not experience symptoms. However larger fibroids may make examination of your ovaries impossible if they grow near your ovaries.

An ultrasound scan is often ordered when such masses are felt by your physician to determine the cause of the mass, however some fibroids appear on sonograms as ovarian tumors and surgery is the only way an accurate diagnosis can be made.

Although most fibroids cause no symptoms, the estimated 25% of women who do have symptoms may have abnormal bleeding, pain during menstruation, and as the fibroid tumors grow larger, women will often experience a swollen abdomen.

Larger fibroids may cause frequent urination or an inability to control your bladder, either the ability to control the urge or in severe cases, a women may find that she is unable to urinate at all. If a fibroid extends towards a woman’s back it may push on the bowels, causing constipation and a backache.

Treatment of Fibroids

If your fibroid tumors are severe enough that they cause certain symptoms, surgery is often, the only treatment your doctor may recommend. Symptoms which you may be told justify surgery include: extremely heavy bleeding during your menstrual cycle, which causes anemia that does not respond to treatment; pain, which has become intolerable to the woman or discomfort caused by the pressure of the fibroids on another organ or when the location of the tumors is likely to cause further problems.

Surgery for fibroid tumors includes, myomectomy and hysterectomy. Myomectomy is the surgical removal of each individual tumor without damage to the uterus, preserving a woman’s ability to conceive. However, in the absence of sufficient natural progesterone, fibroids will often grow back and although it is possible to have a myomectomy repeated, multiple myomectomies can cause other problems such as the walls of the uterus sticking together due to scarring.

Women should also consider uterine artery embolization. Uterine artery embolization leaves the uterus intact in a non-surgical procedure. Polyvinyl particles are placed into the uterine artery at a point just before the nexis of vessels spread out into the uterine tissue. The particles flow into the vessels and clog them. This prevents the fibroids from receiving the constant blood supply they require and causes the fibroids shrink overtime. However, almost immediately the symptoms of heavy bleeding and pelvic pain are significantly reduced.

The sad fact is that in the absence of sufficient natural progesterone, fibroids do grow back and most women eventually have to face a hysterectomy decision. Removing the uterus is the only permanent way that most doctors know to effectively relieve most women of fibroids.

Unfortunately, a hysterectomy is, most often, the procedure of choice for:

fibroid tumors when a woman with severe symptoms, has passed child bearing years and her uterus has grown to the size of a uterus at twelve weeks of pregnancy;

excessively large fibroid tumors;

severe abnormal bleeding;

the fibroids are causing problems with other organs such as the bladder and bowels.

Science is starting to evaluate other options for treating fibroids, including the use of Lupron which may be beneficial for those who want to become pregnant or for women approaching menopause when fibroids often shrink naturally. Lupron shrinks fibroids in most women with continued use, but one drawback is that the fibroids will quickly grow back once treatment is stopped. Many informed women have chosen to monitor their consumption of environmental estrogens (xeno-estrogens) and use progesterone in cream form. This safe, natural alternative to surgery is gaining acceptance among many members of the medical profession.

If you have fibroid tumors, carefully investigate your options before deciding what treatment you want to try. There are many alternatives to hysterectomy currently available, and science is creating more options for women.